A case series of intrauterine fetal myelomeningocele correction through mini-hysterotomy - Outcomes of the modified approach

Sunday, May 5, 2024

4:37 PM – 4:39 PM CT

Location: S405b

Presenting Author(s)

Fernando C. Gomes (he/him/his)

Medical Student
Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil

Co-Author(s)

BC

Bruno S. Costa, MD, PhD

Residency Program Coordinator
Neurosurgery Department, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil., United States
Fd

Franklin B. F. de Lima, MD

Attending Physician
Neurosurgery Department, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil., United States
Fd

Fábio B. de Mesquita, MD, PhD

Fetal Surgery Coordinator
Fetal Medicine Department, Fetali Medicina Fetal e Ultrassonografia Center, Belo Horizonte, Brazil, United States
MD

Marcos Dellaretti, MD, PhD

Attending Physician
Neurosurgery Department, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil.
Belo Horizonte, Brazil
MP

Marianna A. Pedroso, MD

Attending Physician
Fetal Medicine Department, Fetali Medicina Fetal e Ultrassonografia Center, Belo Horizonte, Brazil, United States

Disclosure(s):

Fernando C. Gomes: No financial relationships to disclose

Introduction: Fetal myelomeningocele (MMC) repair has emerged as the preferred treatment method due to its superior neurological and motor outcomes compared to postnatal correction. There are, however, concerns about perinatal complications. We present our experience with fetal MMC treatment via mini-hysterotomy, a modified open procedure that seeks to reduce maternal and perinatal morbidity.

Methods: Patients underwent fetal MMC repair through a 2.5-3.5 cm hysterotomy, otherwise similar to the traditional open technique of placode closure. We recorded data on operative time, maternal and fetal perioperative complications, rate of preterm births, and neonatal sequelae.

Results: A total of 32 patients at a mean age of 28 (±7) years old underwent fetal MMC repair at an average gestational age of 24.08 (±1.39) weeks. The mini-hysterotomy averaged 3.26 cm (±0.49), total surgical time averaged 3.31 (±0.31) hours and fetal surgery duration averaged 58.8 (±18.5) minutes. Neural placode closure was achieved in all cases, Chiari II was completely resolved in 19 (82.6%) and partially in 3 (13.0%) out of 23 available for follow-up. One case of chorioamnionitis and one pulmonary edema were the only maternal complications (6.25%). Two cases (6.25%) experienced fetal bradycardia, without further complications. Two deliveries occured via vaginal birth (6.25%). The mean gestational age was 34.5 (±2.9) weeks. Preterm membrane rupture occurred in 15 cases (46%). At birth, 28 neonates (87.5%) exhibited partially or completely preserved lower limb motility. No cases of intrauterine or perinatal mortality were observed. Skin dehiscence occurred in four neonates (12.5%).

Conclusion : We present a case series with encouraging results of patients who underwent MMC repair through mini-hysterotomy, with a low rate of complications when compared with MOM´s Trial data. Larger studies comparing the techniques are needed to verify these findings.